Keeping Abreast

Breastfeeding is, undeniably, one of nature's most natural, instinctive and beautiful acts, but that doesn't mean it doesn't come with its fair share of challenges and questions. Here's some confidence-building information that can keep you going when things get tough.

Q: Should I avoid gassy or spicy foods to help prevent gassiness in my baby?

A: Many a mom has heard that certain foods—citrus fruits, beans, broccoli, chili peppers, garlic and onions, to name the most notorious offenders—should be avoided like the plague while breastfeeding. But if you ate these foods during your pregnancy, they probably won't bother your baby now, says Ruth Lawrence, M.D., a professor of pediatrics and obstetrics-gynecology at the University of Rochester School of Medicine in New York and the immediate past chairwoman of the American Academy of Pediatrics' section on breastfeeding.

On the other hand, if you ditched the chili sauce and gassy veggies due to heartburn or nausea, you may want to forgo these types of foods for the first month or so, as they can cause a case of "24-hour colic" in your baby, Lawrence adds. After the first four weeks or so, try introducing them one at a time and watch your baby for fussiness for 24 hours before eating another.

Whatever you do, don't eliminate these types of foods unless necessary. A varied diet will provide your little one with a wider range of nutrients and could make her more receptive to new flavors when she starts eating solid foods.

Q: My breasts feel (and look!) like watermelons. Is there anything I can do to relieve the swelling?

A: Frequent nursing is the best way to ease engorgement, which typically occurs 72 hours after giving birth and can last up to a week, or until your milk production system adjusts to the job at hand. Meantime, aim to breastfeed eight to 12 times a day, or about every two to three hours, for the first several weeks. Before each session, apply warm compresses and hand-express a little milk to soften your breasts and help your baby latch on, advises Jane Morton, M.D., a pediatrician at Burgess Pediatrics in Menlo Park, Calif., and former director of the Breastfeeding Medicine Program at Stanford University in Palo Alto, Calif. And beware: You may become engorged at any time—even after your milk production system has regulated itself—if your baby goes longer than usual between feedings because she's sleeping for extended periods, for example.

Q: I'm afraid that I'm not always producing enough milk. How can I tell?

A: If you're nursing frequently and effectively and taking good care of yourself, you shouldn't have trouble producing enough milk. You'll know you're on the right track if you can hear your little one swallowing as she nurses and if she sleeps for a few hours after feedings, pees frequently (wetting six to eight diapers a day), has very light-colored urine and is gaining weight well, says pediatrician and breastfeeding advocate Harvey Karp, M.D., FAAP, creator of the DVD and book The Happiest Baby on the Block(Bantam).

Breast milk production is based on the law of supply and demand, so to ensure that your production stays high, your best bet is to nurse, nurse, nurse. The first few days after delivery are particularly crucial, as that's when you "program" your breasts to establish a healthy, flexible supply, Morton notes. "You can't over-breastfeed a baby," she says. "In fact, problems such as jaundice, excessive weight loss and impaired milk production are less likely the more you nurse in the first three days." It's also important to eat well, drink plenty of fluids, avoid excessive exercise and sneak in as many naps as possible. "Nothing is more detrimental to milk supply than fatigue," Lawrence says.

If you do seem to have a problem—and some women do—you can use a breast pump to increase your production, Karp says. Start by pumping an ounce or two about 30 minutes to 45 minutes before your baby's first morning feeding; she should fall into an eating routine fairly early on, so it will be easy to predict when she'll want to nurse. Gradually work up to pumping two to three ounces two to three times a day, if necessary, and store the excess in the refrigerator or freezer.

Q: I'll be going back to work when the baby is 12 weeks old. What's the best way to introduce a bottle?

A: When your baby is nursing well (usually by 2 weeks to 4 weeks old), give her a bottle of pumped breast milk once a day. Don't wait longer than 4 weeks of age, or she'll be more likely to refuse it. Also try not to give more than one bottle per day—you don't want her to begin to favor the bottle's faster, easier flow.

Q: My nipples are raw and cracked. What can I do?

A: Painful, cracked nipples are most often caused by an incorrect latch, Morton says. So when you breastfeed, make sure your baby is positioned properly: with her belly against yours, so her neck is not turned. Also ensure that she positions the nipple far back in her mouth and draws in the portion of the areola below the nipple.

If adjusting your nursing style doesn't help, consult a lactation expert as soon as possible; visit the International Lactation Consultant Association at ilca.org for a referral. In the meantime, for relief, try applying a touch of expressed breast milk, medical-grade lanolin (unless you're allergic to wool) or an all-natural ointment such as Motherlove Nipple Cream. Wearing breast shells in your bra to expose your nipples to air and prevent fabric from rubbing against them can also help; ask a lactation consultant.